A tensilon test, also called an edrophonium test, is a pharmacological test used for the diagnosis of certain neural diseases, especially

myasthenia gravis Myasthenia gravis (MG) is a long-term neuromuscular junction disease that leads to varying degrees of skeletal muscle weakness. The most commonly affected muscles are those of the eyes, face, and swallowing. It can result in double vision, ...

. It is also used to distinguish a myasthenic crisis from a

cholinergic crisis A cholinergic crisis is an over-stimulation at a neuromuscular junction due to an excess of acetylcholine, as a result of the inactivity of the acetylcholinesterase enzyme, which normally breaks down acetylcholine. Signs and symptoms As a resul ...

in individuals undergoing treatment for myasthenia gravis. The test has fallen out of use due to suboptimal sensitivity and specificity as well as associated adverse risks. Edrophonium is no longer available in the United States and many other countries as of 2018.

Procedure

A 10 mg edrophonium chloride syringe and a 2 mg

atropine Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically give ...

syringe are prepared. Atropine is prepared for immediate use in case cholinergic crisis occurs. After a neurologic examination and recording of vital signs, 2 mg edrophonium is injected intravenously. After waiting 30 seconds and ensuring that no adverse reactions have occurred, the remaining 8 mg of edrophonium is also injected. The patient is then asked to perform repetitive tasks, such as lifting an object or opening and closing the eyelids. Under the influence of edrophonium, patients with myasthenia gravis are able to complete these tasks more easily and with more strength than before the injection was administered. The effects of edrophonium last around ten minutes. The edrophonium allows accumulation of

acetylcholine Acetylcholine (ACh) is an organic compound that functions in the brain and body of many types of animals (including humans) as a neurotransmitter. Its name is derived from its chemical structure: it is an ester of acetic acid and choline. Par ...

(ACh) in the neuromuscular junctions and makes more ACh available to the muscle receptors, thereby increasing muscle strength in myasthenia gravis. In newborns, a 0.15 mg/kg dose of neostigmine administered subcutaneously produces a response within ten minutes. In infants, the drug is administered

intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...

ly at a dose of 0.2 mg/kg. Improvement of

diplopia Diplopia is the simultaneous perception of two images of a single object that may be displaced in relation to each other. Also called double vision, it is a loss of visual focus under regular conditions, and is often voluntary. However, when occ ...

is often used as an evaluation item because in this case,

placebo effect A placebo ( ) can be roughly defined as a sham medical treatment. Common placebos include inert tablets (like sugar pills), inert injections (like saline), sham surgery, and other procedures. Placebos are used in randomized clinical trials ...

can be excluded.

Precautions

The tensilon test is administered by a trained clinician, usually a

neurologist Neurology (from , "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the ...

. A thorough history taking and physical assessment is done before the administration of test, to rule out

hypersensitivity Hypersensitivity (also called hypersensitivity reaction or intolerance) is an abnormal physiological condition in which there is an undesirable and adverse immune response to an antigen. It is an abnormality in the immune system that causes Imm ...

pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

lactation Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The process ...

, and intestinal obstruction. Care is taken while performing the test in individuals over 50, and those under

corticosteroids Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invol ...

or pro-

cholinergic Cholinergic agents are compounds which mimic the action of acetylcholine and/or butyrylcholine. In general, the word " choline" describes the various quaternary ammonium salts containing the ''N'',''N'',''N''-trimethylethanolammonium cation ...

drugs. Vital signs are monitored before, during, and after the test. The test should only be performed in a medical center equipped to manage

. Following the test, the patient is observed for cholinergic responses such as increased salivation, lacrimation,

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat. Over 30 d ...

, and

vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...

References

{{Reflist Diagnostic neurology Diagnostic ophthalmology